I always want to start by recognizing COVID-19 as a legitimate medical disease. Between January 1 and April 1 of this year, it killed 46,438 people according to worldometers.info. It has killed people since, but nobody will ever know the true number. It has led to hospitalizations of many more. The suffering of those patients and their families is real and should never be minimized. They absolutely have my concern and sympathy. However, from an epidemiological standpoint, there are bigger threats. For those who immediately scream on social media, “THIS IS NOT THE FLU!!!,” you are correct. I remain firmly convinced influenza is deadlier. I have treated influenza, as many as 62 patients in a single 24 hour period. I have admitted patients from the ER who would not survive it. From January 1 to April 1 of this year, under the same social distancing, same shelter in place, and even handicapped with a vaccine, the flu still killed 121,993 people, more than two and a half times the deaths accounted for by COVID-19. Antibody testing is now showing COVID-19 to be more prevalent than originally thought but those same studies are essentially reinforcing that most never knew they had it. Everyone knows they had the flu. To bring things further into perspective, malaria killed 246,121, cancer 2,060,730, and hunger 2,806,314 in the same time period.
I will be using an analogy throughout much of this paper. When I compare our immune systems and COVID-19 to a football team, it is not to minimize its’ importance. It is simply to illustrate why our response to this coronavirus has been so frustrating. Football is important to our nation, but especially the South. We live it. There are radio stations where you can call in and talk college football 365 days a year. If football is not as important in your region, understand that everyone locally will get this analogy immediately, so try to comprehend it from that perspective. Our local team is the Alabama Crimson Tide. Fortunately for the purposes of this illustration, they are really good. I equate the immune system of a healthy person to the Alabama football team. A healthy person has a strong immune system just as Alabama has a strong football team.
Imagine if you were me or someone who feels as I do (and there are plenty of us), and you have been transported to some bizarre world where it feels like no one knows anything about football. Alabama has been scheduled to play a new opponent, COVID-19. Coronaviruses as a whole are not typically significant pathogens to humans. Think of them as a weaker football conference. They have fewer scholarships and inferior facilities. They may occasionally defeat a bigger program but do not represent as strong a threat typically. Admittedly, COVID-19 has never been on the schedule before, and maybe they are located on the West Coast with some Nike funding, but they are still a lesser squad. You are a 365 day a year fan so you do your homework. They definitely seem to be better than their conference brethren. Maybe they have a decent quarterback and a speedy receiver. But Alabama has the edge overall. Our O line significantly outweighs COVID-19’s D line. We have superior team speed. Our defensive linemen are All Americans. COVID-19 plays some exhibition games overseas. The suffering in Italy is regrettable but not surprising. Italy’s program is a mess. They have limited resources due to socialized medicine, 60 million people on a much smaller land mass, and one of the oldest populations of the world. They were overwhelmed by influenza during the 2017-18 season. Alabama will take COVID-19 seriously, but you feel pretty good about where they are. Coach Saban will have them ready.
Unfortunately, Coach Saban will never have the chance to coach against COVID-19. Not just ESPN but the national media starts talking about this COVID-19 squad. In fact, the national media, which normally doesn’t put much coverage into health issues at all, decides they will talk about nothing BUT this squad. It goes on for months! Coach Saban is replaced by President Trump and Nancy Pelosi and they choose Dr. Fauci as their advisor. He hasn’t actually coached a football team in more than twenty years. His early predictions are all over the place. Within a week he predicts Alabama will win easily and revises that to they will likely lose by at least three touchdowns. Somehow no one around you finds this odd and he keeps his job. You can provide game film of COVID-19 but they won’t watch it. CNN has described their lineman as 560 pound giants with lightning speed and even though you can disprove it, no one will listen.
Initial reports of those infected with COVID-19 start coming in from America. ESPN reports NBA Utah Jazz center Rudy Gobert has become ill with COVID-19. His symptoms are mild but the NBA can take no chances. They cancel their season. Although most of the hundreds they test did not contract the disease, a few did. Most did not know they had it. But there is a chance they might spread the threat elsewhere. ESPN reporters insist the NCAA cancel their seasons as well and everything starts shutting down. Not just the NCAA but all other professional sports and even high school sports.
The country begins closing down as well. Despite the minimal impact it had upon NBA players, it is decided the disease is best treated by avoiding it altogether. Governors and mayors start ordering things like shelter in place and demand “non-essential” businesses close. No one seems to point out there is nothing non-essential about making a living and providing for one’s family. These same politicians schedule regular press conferences and expound on all they are doing to keep you and your neighbors safe with occasional requests for federal aid.
You are watching these politicians put offensive linemen at receiver, a linebacker is playing quarterback, and the defensive backs and defensive linemen have switched positions altogether. It is a disaster. But CNN, MSNBC, ABC, NBC, and CBS reinforce daily the need for the strategy. Your neighbors start wearing “Fear COVID-19” masks and “Fear COVID-19” gloves. Callers to local sports shows and radio sports personality Paul Finebaum, most of which have never had COVID-19 and don’t know anyone who has, weigh in on the dangers it represents. None of it makes any sense.
To make matters worse, they are sabotaging the future. They have shut down the economy. Think of that as recruiting. Imagine if your program was recruiting receivers who are slow and drop passes or 150 pound linemen who can’t bench their body weight. The damage this is doing to your program will go on for years!
Around the end of March others around you get the idea COVID-19 might be something our immune systems can handle after all. Then the tickers along all those news stations start showing a spike in death tolls. From a medical standpoint, the CDC changed their criteria so that patients did not have to test positive to die from COVID-19 and, additionally, patients who did test positive did not necessarily have to die of COVID-19. Some have had it and clearly died of another cause but are included in death totals. No distinction is being made between those dying WITH COVID-19 and those dying OF it. Hospitals are reimbursed at a higher rate if COVID-19 is included. (This information is not difficult to find but searching for Minnesota physician Scott Jensen will do it.) From a football standpoint, they won some games where the refs were paid off and given some wins in games they didn’t even play. I did not watch the NFL draft but I am told ESPN’s coverage reinforced fear by including constant references to COVID-19. However, I want to wish Giants GM, David Gettleman, whose pictures were circulated wearing a mask at home, continued good health as he has survived lymphoma.
David Gettleman’s situation is simply a reminder COVID-19 is a potentially deadly illness. Precautions are not inappropriate for the elderly or immunocompromised. But if you are not in that category, think about whether you want to wear masks and gloves the rest of your life. COVID-19 may go the way of SARS and MERS, but it will most likely persist given its’ higher transmissibility among humans. Influenza isn’t going anywhere. It will be back next year with a new lineup and we will try to come up with an appropriate vaccine. If you haven’t worn masks and gloves every flu season, is that something you really want to start doing? Those steps aren’t without implications.
Your immune system really is very good, but while you shelter in place, you have put your players on the bench. They aren’t working out, and they aren’t playing. Your immune system isn’t getting stronger every day. It normally plays in the SEC. It faces opponents like Streptococcus pneumonia, Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, and Influenza. Think LSU, Auburn, Georgia, Texas A&M, and Florida. By the way, all those opponents ARE still in training. In fact, they are facing even tougher workouts as your neighbors are using millions of pounds of disinfectants across the country. Overutilization of pesticides and antibiotics has never worked out well in the past. We tried to kill fire ants upon their arrival with widespread poisoning. We wiped out the native ants and hastened the spread of the fire ants themselves. Using antibiotics without indication only creates resistance. Yes, be smart, wash your hands, and don’t eat or drink after others. But do we really need to Lysol the check out counter between every customer at the grocery store?
Some may still feel it is irresponsible to open back up, despite all the evidence to the contrary. I will point out that, just at COVID-19 numbers are rising while we shelter in place, some individuals will become infected by both COVID-19 and other contagious diseases after we reopen. As we will always share our world with viruses and bacteria, this will always be the case. But if you resist reopening, you should at least consider the alternative. We KNOW what will happen if we don’t. Businesses are not just shut down but their owners are filing articles of dissolution. That means they are closing PERMANENTLY. They won’t reopen. Twenty-six million have filed for unemployment. It has risen four million since my original paper! How in the world are we still ignoring that and the massive health implications? Meanwhile, I KNOW over 40,000 women will die of breast cancer this year and some of them have palpable, yes palpable, masses growing right now and their doctors won’t see them. More than 50,000 Americans will die of colon cancer and colonoscopies are on hold. Doctor’s offices are empty and more people will die of heart disease, hypertension, and diabetes than COVID-19 will ever dream of harming. It is estimated 300,000 will die of obesity or complications and we are sending memes about how much weight we are gaining instead of correcting both our behaviors and the mess the RESPONSE to this virus has created.
Speaking of nutrition, I mentioned hunger was responsible for 2,806,314 deaths globally in the first three months of this year. America has always been the land of plenty, and while undoubtedly some have experienced hunger, starvation is rare. However, because we have shut down processing plants we are threatening our own food supply. Millions of chickens, along with thousands of harvest-ready steers and pigs, are being euthanized and buried. Crops are being plowed back into the earth instead of making their way to tables. Milk is being poured onto the ground rather than being placed on grocery store shelves. We can print Monopoly money. We can not print Monopoly food.
Most of my arguments to this point have focused on the physical and sociological effects of our response. There are also psychological effects. Locally, two elderly women were neighbors at an assisted living facility for years. They had both declined in health to the point where assisted living was no longer an option. They had to transition to a nursing home. The plan was for the two friends to share a room. Unfortunately, the timing of their decline coincided with our COVID-19 response. Upon moving into the nursing home on April 1, the two women, neither of whom exhibited evidence of an infectious disease, were to be “quarantined” for 14 days. One of the women would suffer a fall and be admitted to the hospital instead. Current limitations on visitation made it difficult for her family to see her. The other was moved to the nursing home. There she was also separated from her family. Only window visits were allowed. On April 14th, the same day her friend would pass away, she was moved to a courtyard room where even window contact was impossible. She died on April 21st. They both died alone. We are supposed to be social creatures. We are supposed to hold each other’s hands and embrace. We are not meant to regard each other with suspicion in a grocery store. And somewhere, a hospital administrator is trying to figure out if death from loneliness qualifies to list COVID-19 as a comorbidity.
I hope you can understand why I am so angry. I hope you can understand why I am confused others are not. I wrote the original paper April 19th. Do you know what I should have been doing the exact same time? My original schedule was to drive to Montgomery to watch my son, who is a senior, play for the state tennis title with the rest of his team. They were runners-up last year and most of our team was back. My son focused on baseball early on and didn’t pick up tennis until he was a sophomore. This was his first year as part of the starting line-up after working over two years to get there. He was undefeated when their season was cancelled. His mother and I, along with millions of other American mothers and fathers, will never be able to replace those seasons for our children. Many of us with seniors will never get to see them play again. Members of this year’s class have lost the proms and graduations they earned over 18 years. Based on all public data currently available, COVID-19 was not, is not, and, barring some unforeseen mutation, will never be a significant threat to those under 18 with a healthy immune system. Why in the world did we cancel school?
But, ironically, in the sacrifice of those kids’ dreams I see a ray of hope. After their seasons were cancelled, ESPN decided to visit some of those teams. As teammates cried and hugged each other, did you see any that segregated because of color or sexual orientation? I sure didn’t. They were all hurting because of a common loss. I know I am an idealist, and I know I am about to sound naïve, but don’t we all have a LOT more in common with EACH OTHER than we do with either Donald Trump OR Nancy Pelosi? What we have done and tolerated is hurting ALL of us. I don’t see how we survive as a nation if people keep turning off instantly when they hear a keyword. You can post of picture of Trump with an Obama quote and it is immediately hated and/or loved by some before they ever consider the content. You can post a picture of Obama with a Trump quote and find the same. I don’t have a third party to offer you. Examine all that has happened and evaluate the impact of politicians on both sides. Pick the best option but DON’T STOP THERE. Pay attention and demand they stop taking money from drug companies who are then allowed to charge more. Ask them to explain why the Affordable Care Act means you pay higher premiums and deductibles for less coverage. Surely we can make at least SOME difference if we stop letting them divide us and find common ground on social issues instead of just the common ground we have on the baseball and football field.
Speaking of dividing us, we have to do something about the media. We have to. I am fully aware someone in the media will respond to this, and ethical journalists still exist, some of whom have reached out to me, but ethics as a whole appear to have left both journalism and the media a long time ago. Headlines have been misleading throughout this ordeal. Major news corporations have been caught in active lies. We tolerate “unnamed sources” as long as the network is big enough to be on TV or the internet. They wage war on us by focusing on fear of the disease with occasional references to how much we will suffer from the very real economic disaster that fear has created.
Fortunately, they are not all waging war against us. The best synopsis I have seen of COVID-19 was not provided by a doctor, but a journalist. In The Washington Times on April 28,2020, Cheryl K. Chumley summarizes, “The facts are this: COVID-19 is a real disease that sickens some, proves fatal to others, mostly the elderly – and does nothing to the vast majority. That’s it. That, in a nutshell, is it.”
Disclaimer: I have never claimed to have new data and have cited nothing unpublished. This is a public piece that will never be submitted for peer review. I have no financial interests to disclose. Our clinic numbers were impacted in March and the economic situation uncertain, so I took steps to protect my employees. However, the diseases I treat are responsible for the deaths of over 123,000 Americans per month and I am considered an essential business. In fact, I have written where appropriate, prescriptions free of charge for patients whose doctors have not been available to them.
In addition, although I have heard of specific instances where COVID-19 was added as a comorbidity without laboratory confirmation, I do not mean to imply this has happened in every medical facility. None of the instances I refer to occurred at our community’s hospital. I stated in my first piece Tuscaloosa County reported zero COVID-19 deaths at the time of its’ release.
I can be contacted at email@example.com.
Hi, Dr Bosshardt. I enjoy reading your musings. I enjoyed finding out our common roots with PAA at a recent appointment. I have some information for you regarding that. Is this the best means to communicate that to you?
Karen, Thanks. Best is via email as I check that regularly. I am not good about checking voice messages as I get so many. My email address is firstname.lastname@example.org